Healthcare Provider Details

I. General information

NPI: 1992576326
Provider Name (Legal Business Name): AMETHYST HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 GARRISONVILLE RD STE 205
STAFFORD VA
22554-1603
US

IV. Provider business mailing address

231 GARRISONVILLE RD STE 205
STAFFORD VA
22554-1603
US

V. Phone/Fax

Practice location:
  • Phone: 571-250-9516
  • Fax:
Mailing address:
  • Phone: 571-250-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DARELLYN URENIA QUANSAH
Title or Position: OWNER
Credential:
Phone: 571-250-9516